Normally, endometrial tissue is found only inside the uterus. The uterus is the reproductive organ where a fetus develops. Hormones cause the tissue to form there, preparing the body for a fertilized egg. If you do not become pregnant, the tissue leaves the body during menstruation.
In endometriosis, endometrial-like tissue is found outside the uterus. For example, it may be found on organs in the abdomen or pelvis. In these places, the tissue still responds to hormones. It swells, breaks down, and bleeds. But it is unable to leave when you menstruate. Surrounding tissue becomes inflamed. There is often scarring.
Possible causes include:
- Menstrual tissue backs up through the fallopian tubes and spills into the abdomen
- Immune system may allow the tissue to implant and develop into endometriosis
- Lymph system may carry endometrial cells from the uterus
- Certain cells on abdominal organs turn into endometrial tissue
Hormones and growth factors cause the disease to progress.
A risk factor is something that increases your chance of developing this condition. The following may be associated with endometriosis:
- Family history, a mother or sister with endometriosis
- Early onset of menstruation
- Not having children—Pregnancy slows or stops the disease from progressing. The condition usually resolves at menopause]]> . The symptoms may return with ]]>hormone replacement therapy]]> .
- Prolonged menstrual bleeding (more than 7-8 days)
- Abnormal development of the uterus, with a blocked segment
Symptoms range from mild to severe. You may have many large growths with little pain. Or, you may have small areas with intense pain.
Your doctor will ask about your symptoms and medical history, and perform a pelvic exam. These are best done early in the menstrual period. Since you may not have any symptoms, diagnosis is usually confirmed with a laparoscopy]]> . This test allows the doctor to see if there are patches of endometrial tissue and scar tissue.
The goals of treatment are to:
- Control pain
- Slow endometrial growth
- Restore or preserve fertility
Treatment options depend on:
- Severity of symptoms
- Size, number, and location of growths
- Degree of scarring
- Extent of the disease
- Age and whether you want to have a baby
Your doctor may recommend:
- Over-the-counter pain relievers to ease mild symptoms
- Prescription pain relievers (often needed)
- Nonsteroidal anti-inflammatory drugs to reduce inflammation and help with cramping (best when taken on a regular basis)
Hormones are an option for women who are not trying to become pregnant. Birth control pills and other injectable drugs interfere with estrogen production. These medications may decrease pain and shrink the size and number of endometrial growths.
But endometrial growth tends to come back when the hormones are stopped. A common way to take birth control pills is continuously, so that you no longer menstruate.
If you have severe symptoms or you want to get pregnant, doctors can try to remove endometrial growths. This is often done with laparoscopic surgery. In severe cases, it may be advised to also remove the uterus and ovaries]]> . But this means that you cannot get pregnant.
If you are diagnosed with endometriosis, follow your doctor's instructions .
The American College of Obstetricians and Gynecologists
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Dambro MR. Griffith's 5-Minute Clinical Consult . Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
Endometriosis. The National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/ . Updated February 2006. Accessed June 17, 2008.
Endometriosis: what you should know. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20060815/601ph.html . Published August 2006. Accessed June 17, 2008.
Rakel RE, Bope ET. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.
Ryan K, Berkowitz R, Barbieri R, et al. Kistner's Gynecology and Women's Health . 7th ed. Philadelphia, PA: Mosby-Year Book; 1999.
Last reviewed November 2008 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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